A therapeutic model for a cannabis-based opioid reduction

Spring 2019 Cover Story

Rather than a gateway drug, cannabis is quickly becoming an exit drug as more patients use it along with well-established holistic therapies to reduce their opioid use. This convergence of cannabis and holistic healing is happening naturally. Many of the philosophies behind the wave of holistic medicine that has been building for several decades are completely congruent with the way cannabis is used in a therapeutic way. Nowhere is that convergence more visible than in two sister companies in the Philadelphia area.

The Road to Reboot

For many years after PT school, I focused on generalized physical therapy, Recently I began bringing in movement and other modalities into my therapeutic model, which has made a big difference in patients’ lives. It allows them to feel more grounded.

How Felicia Greenfield-Blau became a managing partner at a truly integrative clinic is, in itself, a story of integration. She originally wanted to be a dancer but wound up studying physical therapy and never left. “For many years after PT school, I focused on generalized physical therapy, Recently I began bringing in movement and other modalities into my therapeutic model, which has made a big difference in patients’ lives. It allows them to feel more grounded.” Along the way she became a mindfulness meditation practitioner and brought that into her physical therapy model. Then a year ago her journey took a sharp turn. “I went on a job interview and met an amazingly brilliant guy named Steve O. who had this vision of physical therapy that included ambient lighting, high-frequency music, theta waves, Chinese medicine, acupuncture, chiropractic, occupational therapy, and physical therapy and I just fell in love. She was determined to become partners with him. He needed her help in the PT clinic as he is also the owner of Restore Integrative Wellness Center, Reboot’s sister company, a medical marijuana dispensary with two locations and four more coming. She spent much of the last year becoming a cannabis educator, going out into the community to teach patients how to manage their pain in different ways. In March, she became co-owner and managing partner, along with Steve O., of Reboot Integrative Wellness Center.

Integrating Cannabis

Felicia sees physical therapy and medical cannabis as the perfect combination. She is able to ask her pain patients, “Have you thought about medical cannabis? Have you thought about how these pain medications are working fo you?” “Through these really beautiful honest conversations,” she explained. “I’m able to build a trusting bond with my patients where they realize I’m not trying to threaten them or take anything away from them, but I’m trying to enhance their quality of life and get them to be more functional. It’s been really amazing.” How do her patients react to cannabis? “People are so hungry for something new, something different than they’ve already been doing. People are suffering on many levels. I think we are lonely as a community and as a culture. We are alone in dealing with trauma and everyday stressors. So a lot of my patients are open to the conversation. People who are taking a lot of pain medications are open to exploring. “I help patients that might be a little skeptical to see the evidence that we have so far, that there is something here, something worth looking into. While we may not have as much research and evidence-based data at this point, I think it’s worth exploring. And people who are taking a lot of pain medications are willing to be open to exploring eastern and western medicine.”

Opioid Reduction Program

It’s about having beautiful honest conversations about what is working so far, and let’s experiment! Let’s experiment together.

The rich tapestry of modalities she brings to the table reach their full potential with her opioid reduction program. Her goal is to “bring mindfulness, eastern and western medicines all together under one label.” She uses these tools every single day “because patients are in pain.” What are the main tools used in her program? “We use traditional therapeutic modalities such as electric stimulation, moist heat, infrared. I’m a bodyworker so I do a lot of manual therapy like myofascial release, craniosacral work, muscle energy work. That is the majority of my practice. I have very strong hands. “We also are very evidence-based, so we do a lot of modalities that include therapeutic exercise, functional activities, neuromuscular re-education. These are all things that help patients with balance, coordination, where they are in space and how to be more comfortable getting out of the car, getting up and down the stairs, getting in and out of bed. “My partners in the clinic are a chiropractor and a physical therapist who is also an acupuncturist. Our whole model is about eastern and western medicine. It’s about having beautiful honest conversations about what is working so far, and let’s experiment! Let’s experiment together. I think when people don’t feel so alone and vulnerable, they are willing to take a ride into something new.”

More than a Pain Clinic

Felicia’s patients come to her for a variety of reasons. “I have patients who have sought me out just to do mindfulness meditation with them. I have people who have sought me out because they are dealing with addiction issues. While my ancillary practice is to help people reduce their opioid use, my primary goal is to help people get back in touch with their bodies. Kind of getting grounded. Let’s take a nice deep breath and figure out what is part of the problem that is leading you to have this addiction, leading you to have this chronic pain.” These deep conversations unlock the emotions that have been stuck. “I think the emotional component with the physical component is where people have the best results. Using the traditional therapy model while doing mindful meditation, while helping patients know what’s working with their medications and speaking closely with their physicians — patients don’t feel like it’s segmented. I want their physicians to be on this journey with them. I want everyone to have a seat at this table.“ Felicia is adamant about the physician being the only one who changes a patient’s opiate intake. “I would never tell any of my patients to lower their medication. As long as the physician knows I’m working with the patient and what my goals are, they are able to be more directly involved.” She likes to bring more medical professionals to the table. “Do they need to see a nurse practitioner regarding some of their symptoms? Or a nutritionist? Or a psychotherapist?

Let’s bring everybody in. I’m the person who is delving into these deep conversations that are allowing other work to happen.”

Educating About Cannabis

It’s an amazingly complex system and yet so simple as well. When we understand how slight changes can impact a whole quality of life.

Felicia outlines the steps she uses to help new cannabis patients get started. “I help people register to get their card and find physicians who give significant discounts so they can get registered. Then I guide them through the process of what to expect when you go into a dispensary.”

She even has patients on the phone while talking to a pharmacist in the dispensary, guiding the decision they are making. While she gives each patient as much information and education as she can, she has high praise for the education provided by the dispensaries she has worked with. “I love the people at the dispensaries. These amazing visionaries who have found work in this area to do what they do best, saying this strain or this product or this grower/processor gives us this medicine.”

She gives all the local dispensaries very high marks. “They all have a different philosophy and each brings something different to the table. It’s important for patients to know there are great leaders and great pharmacists working in all these dispensaries. I do personally love the model at Restore, because it’s very medically based, and my partners and I are medically-based practitioners. I like that they are looking at what patients’ physical and emotional needs are, then recommending cannabis medication that will help them achieve those functional goals, which is what I am ultimately working on. Ultimately what’s most important is debunking the myths and helping patients know that this beautiful endocannabinoid system that we have has not been utilized well enough and I am all about figuring out how to get this system back into homeostasis. It’s an amazingly complex system and yet so simple as well. When we understand how slight changes can impact a whole quality of life.”

She gushes about how the different cannabinoids and terpenes working together create the entourage effect and how this is ultimately why her program is successful “People are needing less of these medications once they are able to make that leap.” Whether it is the entourage of cannabinoids and terpenes or the entourage of the whole integrated healing team she puts together, one certainty is that Felicia’s patients are the beneficiaries of the effects.